Laserfiche WebLink
, <br /> Date � � r„e��<<vo,ks P�,�w , �b'—oZS�s_ <br /> � � <br /> Application For oin�.oroi n <br /> � <br /> PfJIB�IC WORK� PERIVIIT �'ublr<WarYSFce -- <br /> Ta�,�F�� s <br /> Less Fppl.Fee Pm� S� <br /> Print or Type Only �alanceDue S �O � <br /> � <br /> r���p�'1 ���3� I�'l�h C`;-� �"B�t Z. I���t�'� �'4"�7Z <br /> O Mai{ing Address City Zip Phone I <br /> _ ��� py IT' �J�"� �� /�1�� � <br /> —*o�bb0�—li <br /> Applicant Mailing Atldress City Zip Phone <br /> Describe Proposzd Work �1'—/C � C J I I � Cl'�K�JI� 1��J � I' <br /> � <br /> I <br /> Proled Address(if known) �SL2y — �� � t,s'c-. .SE_ � <br /> AUach �our(4� copies of plans for proposed work- Draw to scale and note Ihe following as applicable� � I <br /> • Property Lines • Centerline of sireet /p I <br /> • Outline and dimensions of all existing and • Indicate North Vr <br /> proposed strectures on the lot • Show any proposed gradiny changes <br /> • Existing and proposed utilities • Show measuremenls � <br /> DO NOT WHITE �ELOW THIS LINE <br /> PEflM1T CONDITIONS � <br /> 7.Ail calls for inspection sho�i be made 24 hrs in advance-phone 259-8810. � <br /> 2.All work shall be pedormed in accordance with ihis permit and current City of Everett Design ar.d Conslruction <br /> Standards and Specitications. <br /> 3.Cali '._ocation Underground Seivice 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424-5555. _ <br /> �F,fi!�Il' ci���r.�c;r: rr� rFir nr,r.vt�tar,v CUT t4UST RF AP'PFiOVED � � <br /> I:+Y TIiE: 1-�UE+LIr LdORh::S fNSFErTOh. � <br /> �, I.i;>� F'UF:LIC DF;AINAG[- Sl'STEt9 A:i F'FfOVIDE)) FOF riOi���.i,f;��[III ; ;�, <br /> `._ill�lY LQT GFFiDEi CHANGF5 MUST L'iF_ AFF'f:04FD EY TI 11 i <br /> ='Uk�L.T _r. blOF2k:5 J:NSF'FCfOF'. � <br /> ' I EC�' GTT"� ,TRFElS CI_�(1N (1T �LL. TIh1F_S. <br /> : ', I�4!�T[.1L.L. l�Jl�lF.Fi F'1XES TD GRADF_ (1'f THF ENI) OF CO�•I;; (rJl'.'l 1:i7;.! � <br /> `- Y'Il11 C �LiFE DIiIVEtJ(-1`/S f-1RE COMF'Lf_TFI_'✓ r�UREJ HI'PQRE � <br /> L 1VJ11f� J�� iHFM. <br /> �(; , �IV Dr=d Ir1GE TO THE CI 1RF (-1ND �r L1F�JFII f P1I L.L }tC i t; � r�i REJJ � <br /> i �' I I'= � rl7lSf�(1(.��[I)t�l �]f 1I �!: I-I I��i(. i f i �I�SP;S Dk_P7 . <br /> ACKNOWLEDGEME�'? OF CONDITIONS <br /> Th��undersigned ownedapplicant hereby agrees to hold and save harm- li <br /> i les[; Ihe City of Evr.rett from any and all claims for damages, costs, �� <br /> � " expenses. or caus�s of action thal may arise because el installation I� <br /> L�����-��/ �j�j�'� and maintenance of the improvement or other ri�htrof-way use hcreto <br /> applied lor and further agrees to remove same upon notice Irom the <br /> �Approved �rl Con ruction � ���e City and to replar,e public properiy damaged ihereby. �i <br /> !'/ -/ //��/f ��(.'./ ' /;� !/S''�_ / -� � � <br /> FINAL INSPECT�N�C�� • ' Date � l�'�/� - � ?vii 7�C����� : <br /> Approved as Constructed ,3�naWre ol Applicant C��t� ' D� ' <br /> e�^rett PUBLICWORKSDEP.ARTMENT `'y��ORI( AUTHORIZ[D 8Y THIS PERMIT MUST BE STPRTED WITHIN <br /> 3200CedarSireel 1d0 DAYS OF DATE PEFMIT IS ISSUED AND THERLArTER IS TO � <br /> � Everelt,WA 98201 I BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BL' . <br /> Phonr. 259-8810 � i.APiCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> — PROJECT OVER 90 DAYS DURA110N. <br />